Diabetes

Question 1

What term “can” be used interchangeably with diabetes mellitus?

Answer 1

Diabetes

Question 2

What term literally means “excessive excretion of urine”?

Answer 2

Diabetes

Question 3

What condition refers to the disorder of carbohydrate, fat and protein metabolism with absolute or relative insulin deficiency?

Answer 3

diabetes mellitus

Question 4

What 3 metabolism disorders make up diabetes mellitus? What deficiency is included?

Answer 4

Carbohydrates, fat, and protein. Relative insulin deficiency

Question 5

As of 2009, the estimated prevalence of diabetes in Canada was how many Canadians?

Answer 5

2.4 million (6.8% of the population)

Question 6

From 1998 to 2009, what was the percentage of increase for the prevalence of diabetes?

Answer 6

230%

Question 7

Approximately half of the new cases of Diabetes Mellitus diagnosed in 2008/2009 were in individuals aged between what age?

a) 45-64 years old
b) 10-19 years old
c) 30-44 years old
d) 65-74 years old
e) 20-34 years old

Answer 7

A

Question 8

Estimates from the Public Health Agency of Canada suggest that how many Canadians will be diagnosed with diabetes by 2019?

Answer 8

37 million

Question 9

According to the Canadian Diabetes association, which type of Diabetes Mellitus accounts for approximately 90% of diabetes cases?

Answer 9

type 2 (diabetes mellitus)

Question 10

According to the Canadian Diabetes association, what percentage of diabetes cases is known as type 2 Diabetes Mellitus?

Answer 10

(approximately) 90%

Question 11

According to the Canadian Diabetes association, which type of Diabetes Mellitus accounts for approximately 5-10% of diabetes cases?

Answer 11

type 1 (diabetes mellitus)

Question 12

According to the Canadian Diabetes association, what percentage of diabetes cases is known as type 1 Diabetes Mellitus?

Answer 12

5-10%

Question 13

According to the Canadian Diabetes association, other than type 1 and type two, what is the other most common form of diabetes?

Answer 13

Gestational Diabetes Mellitus (GDM)

Question 14

According to CCDSS 2008-2009 data, the prevalence of diagnosed diabetes is significantly lower in which age groups?

a) in adults than adolescents and children
b) in children and adolescents than adults
c) in older adults than adolescents and children
d) in only adolescents than adults

Answer 14

b

Question 15

Is there is a slightly higher prevalence of diabetes in males or females?

Answer 15

Males

Question 16

What is an example of a personal cost of diabetes?

a) Reduced quality of life and increased risk of heart disease/ stroke
b) Kidney Disease
c) Blindness
d) Amputation
e) Erectile Dysfunction
f) All of the Above

Answer 16

F

Question 17

What percentage of people with diabetes will die as a result of heart disease or stroke?

Answer 17

80%

Question 18

Which stage of life are Canadians most likely to die prematurely in, Childhood or Adulthood?

Answer 18

Adulthood

Question 19

Type 1 diabetic’s life expectancy may be shortened by as much as ______ years , while type 2 diabetic’s life expectancy may be shorted by _____-_____ years

Answer 19

15 years and 5-10 years

Question 20

There is a tremendous financial and societal burden to diabetes.

True or False?

Answer 20

true

Question 21

What is the personal annual medical cost for one with diabetes?

Answer 21

$1000 - $15,000

Question 22

Diabetes to cost the Canadian Healthcare System ______ billion per year by 2020.

Answer 22

$ 16.9 (billion)

Question 23

What type of diabetes mellitus accounts for 90-95% of type 1 diabetes?

Answer 23

Type 1A

Question 24

Type 1A Diabetes Mellitus is known as an autoimmune mediated specific loss of beta cells in the pancreatic islets Langerhans.

Answer 24

True

Question 25

Type 1A Diabetes Mellitus is known as an autoimmune mediated specific loss of what type of cells? Where are these cells located?

Answer 25

Beta Cells in the pancreatic islets Langerhans

Question 26

As a whole, type 1 diabetes includes cases of diabetes that are primarily the result of the beta destruction which leads to what?

Answer 26

absolute insulin deficiency (and is prone to ketoacidosis)

Question 27

There is very little research underway looking at the genetic susceptibility to type 1A diabetes.

True or False?

Answer 27

False (There is much research underway looking at the genetic susceptibility to type 1A diabetes.)

Question 28

The strongest association and most studied topic regarding the genetic susceptibility to type 1A diabetes is the inherited major histocompatibility complex (MHC) genes on which chromosome?

Answer 28

Chromosome 6

Question 29

The strongest association and most studied topic regarding the genetic susceptibility to type 1A diabetes is the inherited ________ _______________ __________________(MHC).

Answer 29

Major Histocompatibility Complex (MHC)

Question 30

The strongest association and most studied topic regarding the genetic susceptibility to type 1A diabetes is the inherited major histocompatibility complex (MHC) which encodes for what human leukocyte antigen?

Answer 30

HLA-DQ and HLA-DR (Specifically, HLA-DR3 ad HLA-DR4 is associated with an increased risk of type 1A diabetes that is 20 to 40 times higher than that of the general population.)

Question 31

Some specific human leukocyte antigens are thought to decrease the risk of developing type 1 diabetes including what?

Answer 31

HLA-DR2

Question 32

An insulin gene regulates beta cell replication and function on which chromosome?

Answer 32

Chromosome 11

Question 33

In MOST cases, there is likely a polygenic inheritance of type 1 diabetes, meaning that susceptible individuals have more than one genetic polymorphism.

True or False?

Answer 33

true

Question 34

Between 10% and 13% of individuals with newly diagnosed type 1 diabetes have a _______ degree relative with type 1 diabetes.

Answer 34

first

Question 35

Identifying genes that predispose individuals to diabetes has many advantages and NO disadvantages.

True and False?

Answer 35

False (It also carries many ethical and legal issues.)

Question 36

Autoantibodies specific to beta cell destruction includes what three types of autoantibodies?

Answer 36

insulin (autoantibodies), islet cell (autoantibodies), and other antibodies (directed at other autoantigens) (such as glutamic acid decarboxylase-GAD and tyrosine phosphate IA-2)

Question 37

Environmental Factors - Interaction with Genes

Certain chemicals such as Alloxan, Streptozotocin and Vacor (as well as certain drugs such as Pentamidine) have been associated with what type of diabetes?

bovine milk

Answer 37

type one diabetes

Question 38

Environmental Factors - Interaction with Genes

Nutritional intake of what type of milk have also been linked to Type 1 diabetes?

Answer 38

bovine milk

Question 39

Environmental Factors - Interaction with Genes

Nutritional intake of high levels of what have also been linked to Type 1 diabetes.?

Answer 39

nitrosamines

Question 40

Environmental Factors - Interaction with Genes

Nutritional intake of high levels of what have also been linked to Type 1 diabetes.?

Answer 40

nitrosamines

Question 41

40% of individuals with what type of infection develop type 1 diabetes later?

Answer 41

congenital rubella

Question 42

Persistent cytomegalovirus infection appears relevant in some cases of type 1 diabetes.

True or False?

Answer 42

True

Question 43

Mumps and coxsackievirus seem to have small effects on the development of type 1 diabetes.

True or False?

Answer 43

True

Question 44

There is a seasonal distribution with more new cases reported in what two seasons, in which hemispheres?
(This supports the idea that there is a gene-environment interaction with causes type 1A diabetes.)

Answer 44

Fall & Winter in

Northern Hemisphere

Question 45

Latent Autoimmune Disease In Adults or LADA

There is a small number of adults (approximately 10%) classified as having type 2 diabetes who appear to have immune mediated destruction of beta cells who actually fall into the category of what type of diabetes?

Answer 45

Type 1A diabetes

Question 46

Type 1A diabetes is diagnosed in childhood or adulthood for the most part?

Answer 46

Childhood

Question 47

Diagnosis of type 1A diabetes peaks at ___ years of age and is rare before ___ months of age.

Answer 47

12 years and 9 months

Question 48

What is Idiopathic Type 1B Diabetes Mellitus also called?

Answer 48

Non-immune type 1 diabetes (Type 1B Idiopathic Diabetes)

Question 49

In the case of Idiopathic Type 1B Diabetes, there is no evidence of autoimmunity. The etiology (causes) is unknown.

True or False?

Answer 49

True

Question 50

Idiopathic type 1B accounts for less than what percentage of those with type 1 diabetes?

Answer 50

10%

Question 51

There is a strong genetic component to the development of type 1B diabetes.
Most affected individuals are of what two descents?

Answer 51

African or Asian

Question 52

Affected individuals of Idiopathic type 1B have varying degrees of insulin deficiency that can come and go, which leads to episodic __________________.

Answer 52

ketoacidosis

Question 53

What type of diabetes is a heterogenous condition, characterized by hyperglycemia, insulin resistance, and relative impairment in insulin secretion?

Answer 53

type 2 diabetes

Question 54

Type 2 diabetes is characterized by what 3 things?

Answer 54

hyperglycemia, insulin resistance, and relative impairment in insulin secretion

Question 55

Type 2 diabetes may range from predominant ___________ _______________ with relative insulin deficiency to a predominate ________________ ____________ with insulin resistance.

Answer 55

insulin resistance and secretory defect

Question 56

Environment-Genetic Interaction for Type 2 Diabetes Mellitus

Etiology of type 2 diabetes is thought to not involve an environmental-genetic interaction.

True or False?

Answer 56

False (etiology of type 2 diabetes is thought to involve an environmental-genetic interaction.)

Question 57

15-25% of first degree relatives of people with type 2 diabetes will develop either impaired ____________ _____________ or _____________.

Answer 57

glucose tolerance or diabetes

Question 58

There is a two to fourfold increased risk for type 2 diabetes associated with a positive what?

Answer 58

family history

Question 59

Variants of genes have been identified that increase the risk for type 2 diabetes. Many of them fall in the categories of genetic defects of __________ __________ function and ___________ ____________ in insulin synthesis, secretion and action.

Answer 59

beta cell function and genetic defects

Question 60

Genes // Type 2 Diabetes Mellitus

Others include genes that encode proteins for pancreatic development, amyloid deposition in beta cells, cellular insulin resistance and impaired regulation of gluconeogenesis.

True or False?

Answer 60

True

Question 61

What is included in the top risk factors for type 2 diabetes mellitus?

a) Age
b) Obesity
c) Hypertension
d) Physical Inactivity
e) Family History
f) All of the above

Answer 61

F

Question 62

There is a high risk of developing type 2 diabetes and associated cardiovascular complications with what type of syndrome?

Answer 62

metabolic syndrome

Question 63

Type 2 Diabetes Mellitus occurs mostly in adults or children?

Answer 63

Adults

Question 64

Type 2 Diabetes Mellitus occurs mostly in adults, however there is an increasing prevalence in who?

Answer 64

Children (as childhood obesity rates climb)

Question 65

Which type of children in Canada are particularly affected by type 2 diabetes?

Answer 65

aboriginal children

Question 66

Canadian data regarding the prevalence of type 2 diabetes is limited by US data suggests a 10-30 fold increase in type 2 diabetes in children over the past how many years?

Answer 66

10-15 years

Question 67

What type of diabetes is defined as any degree of glucose intolerance with onset or first recognition during pregnancy?

Answer 67

Gestational Diabetes Mellitus (GDM)

Question 68

What refers to pregnancy in persons with pre-existing diabetes?

Answer 68

Pregestational Diabetes

Question 69

The exact etiology of glucose intolerance in gestational diabetes is very well known, as very detailed reports and cases have been studied.

True or False?

Answer 69

False (The exact etiology of glucose intolerance in gestational diabetes is unknown)

Question 70

Although the exact etiology of glucose intolerance in gestational diabetes is unknown, a combination of what two things are most definitely contributing factors?

Answer 70

Insulin resistance and impaired insulin secretion

Question 71

Older age, family history, history of glucose intolerance, obesity, membership in certain ethnic or racial groups, history of poor obstetric outcomes and infant weighing greater than 9 pounds.

What type of diabetes are these risk factors for?

Answer 71

Gestational Diabetes Mellitus

Question 72

Diagnosis of Gestational Diabetes Mellitus is made based on the gestational diabetes screen which is a _____g glucose load, followed by a ________ glucose level, 1 hour later.

Answer 72

50g and plasma

Question 73

Diagnosis of gestational diabetes is made based on the same lab values than for non-pregnant individuals.

True or False?

Answer 73

False (Diagnosis of gestational diabetes is made based on different lab values than for non-pregnant individuals)

Question 74

Untreated gestational diabetes leads to increased what?

Answer 74

maternal and perinatal (during embryo development) morbidity (If managed well, it is associated with outcomes similar to control populations)

Question 75

In the US, Canada, and Europe, type 2 diabetes accounts for over _____% of diabetes.

Answer 75

80%

Question 76

In the US, Canada, and Europe, type 1 diabetes accounts for over ____-_____% of diabetes.

Answer 76

5-10%

Question 77

Specific Genetically Defined Forms of Diabetes include genetic defects of ________ ________ function and genetic defects in ___________ __________.

Answer 77

beta cell function and insulin action

Question 78

One specific grouping of genetically defined forms of diabetes is what?

Answer 78

MODY (Maturity Onset Diabetes of the Young)

Question 79

Those with MODY (Maturity Onset Diabetes of the Young) present at what age?

Answer 79

A young age

Question 80

Those with MODY (Maturity Onset Diabetes of the Young) have mild disease due to beta cell dysfunction with some _________ __________________ , and inherit the disease via _______________ _______________ transmission.

Answer 80

insulin production and autosomal dominant

Question 81

There is normal insulin sensitivity with MODY.

True or False?

Answer 81

True

Question 82

There have been how many different genetic abnormalities identified that are responsible for beta-cell function impairment? (MODY type 2 and 3 accounts for 15 percent of the cases respectively.)

Answer 82

6

Question 83

These genetic abnormalities are often now referred to as their specific descriptions of known genetic defects instead of MODY subtypes. (For example, MODY 2 encompasses over a dozen mutations in the glucokinase gene on chromosome 7.)

True or False?

Answer 83

True

Question 84

Which two Endocrinopathies and Exocrine Pancreas issues results in diabetogenic effects due to excess hormone levels?

Answer 84

Cushing Syndrome and acromegaly

Question 85

There are also specific genetic syndromes sometime associated with diabetes like __________ __________________ and uncommon forms of immune-mediated diabetes like “________ _________ syndrome”.

Answer 85

Down Syndrome and stiff man

Question 86

Diabetes Induced By Infections, Drugs, or Chemicals

The etiologies for the disorders identified in the “other” section vary, and may be more type 1 in nature meaning what?

Answer 86

beta cell destruction and absolute insulin deficiency

Question 87

Diabetes Induced By Infections, Drugs, or Chemicals

The etiologies for the disorders identified in the “other” section vary, and may be more type 2 in nature meaning what?

Answer 87

relative insulin deficiency

Question 88

When classifying diabetes, it is important to understand the underlying etiology to understand how the disease manifests and the corresponding management.

True or False?

Answer 88

true

Question 89

Glucose is a ___ carbon molecule that is a very efficient fuel, breaking down into CO2 and H2O when metabolized in the presence of oxygen.

Answer 89

6

Question 90

Glucose is a 6 -carbon molecule that is a very efficient fuel, breaking down into ________ and ________ when metabolized in the presence of _______________.

Answer 90

CO2 and H2O and oxygen

Question 91

The brain and nervous system rely almost solely on what as a fuel source?

Answer 91

Glucose

Question 92

Other tissues and organ systems can use other sources of non-carbohydrate fuel such as what two things?

Answer 92

fatty acids and ketones

Question 93

The brain is not able to synthesize glucose or store more than a few minutes worth of glucose supply.

True or False?

Answer 93

True

Question 94

A continuous supply of glucose from the circulation is not typically required to maintain normal cerebral function.

True or False?

Answer 94

False (continuous supply of glucose from the circulation is required to maintain normal cerebral function)

Question 95

Fasting blood glucose is tightly regulated between ___________mmol/L in non-diabetic persons?

Answer 95

4.4-5.0mmol/L

Question 96

What is secreted by beta cells in the pancreas in response to rising blood glucose?

Answer 96

Insulin

Question 97

Insulin secreted by what type of cells in the pancreas in response to rising blood glucose?

Answer 97

beta cells

Question 98

After a meal is ingested, approximately 2/3 of glucose is stored in the liver as what?

Answer 98

glycogen

Question 99

The liver releases glucose by breaking down glycogen in a process called _____________________ to maintain ________________________ between meals.

Answer 99

glycogenolysis and normoglycemia

Question 100

Once the liver and skeletal muscles are saturated with glycogen, additional glucose is converted into __________ ________ by the liver and then stored as ______________________ in adipose tissue.

amino acids, glycerol, lactic acid

Answer 100

fatty acids and triglycerides

Question 101

The liver also synthesizes glucose from what three non-carbohydrate sources?

Answer 101

amino acids, glycerol, lactic acid

Question 102

The liver also synthesizes glucose from non-carbohydrate sources such as amino acids, glycerol and lactic acid in a process called what?

Answer 102

gluconeogenesis

Question 103

What is essential for the formation of all body structures?

Answer 103

Protein

Question 104

Protein are essential for the formation of all body structures including which of the following?

a) genes
b) enzymes
c) contractile structures in muscle
d) matrix of bone
e) hemoglobin of red blood cells
f) all of the above

Answer 104

F

Question 105

What are the building blocks of proteins?

Answer 105

Amino acids

Question 106

There is an unlimited capacity for the storage of amino acids.

True or False?

Answer 106

False (There is a limited capacity for the storage of amino acids)

Question 107

Most stored amino acids are contained in what?

Answer 107

body proteins

Question 108

Amino acids that not needed for protein synthesis are converted to what three things? Then, what is it stored or used as?

Answer 108

fatty acids, ketones or glucose and metabolic fuel

Question 109

Amino acids are broken down from proteins and used as a major substrate for ________________________ when metabolic needs exceed what?

Answer 109

gluconeogenesis and food intake

Question 110

What is the most efficient form of fuel storage?

Answer 110

fat

Question 111

Fat is the most efficient form of fuel storage, yielding ___ kcal/g of stored carbohydrates and proteins.

Answer 111

9

Question 112

Approximately _____-____% of calories are obtained from fat in a normal Canadian Diet.
______% obtained by carbohydrates and about _____% from protein

Answer 112

30-35% and 55% and 15%

Question 113

Many carbohydrates consumed in diet are converted to ___________________ and stored in _____________ ________________.

Answer 113

triglycerides and adipose tissue

Question 114

Triglycerides are composed of what components?

Answer 114

3 fatty acids (linked together by) and a glycerol molecule

Question 115

What is an enzyme that breaks down triglycerides into its 4 components when what occurs?

Answer 115

Lipase and when fat is required for fuel

Question 116

What is then used in the glycolytic pathway and can be used with glucose to produce energy or to produce glucose?

Answer 116

Glycerol

Question 117

What are transported to tissues and can be used interchangeably with glucose for energy in almost all body cells EXCEPT the brain, nervous system, and red blood cells?

Answer 117

Fatty acids

Question 118

Fatty acids are transported to tissues and can be used interchangeably with glucose for energy in almost all body cells EXCEPT in what three areas?

Answer 118

the brain, nervous system, and red blood cells

Question 119

The liver converts left over fatty acids into ______________ and releases them into the ________________________.

Answer 119

ketones and bloodstream

Question 120

What occurs when large amounts of ketones (organic acids) are released into the blood stream?

Answer 120

Ketoacidosis

Question 121

After a meal is consumed, what does the pancreas release in response to increasing plasma glucose? (This allows glucose to enter cells and be used.)

Answer 121

Insulin

Question 122

Glucose that is not needed will go to the liver and be stored as what in skeletal muscle?

Answer 122

glycogen

Question 123

What is largely responsible for the hormonal control of blood glucose?

Answer 123

endocrine pancreas

Question 124

What is the endocrine pancreas is largely responsible for?

Answer 124

hormonal control of blood glucose

Question 125

The pancreas is an organ located behind the _______________ and between the ___________ and the __________________.

Answer 125

stomach, spleen, and duodenum

Question 126

The pancreas is made up of what 2 components?

Answer 126

the endocrine pancreas and the exocrine pancreas

Question 127

Which pancreas produces digestive juices which are secreted into the duodenum?

Answer 127

Exocrine Pancreas

Question 128

What type of cells make up the exocrine pancreas?

Answer 128

Acini cells (secreted via pancreas duct)

Question 129

What duct does the exocrine pancreas secrete digestive juices into the duodenum?

Answer 129

pancreas duct

Question 130

Which pancreas makes up 1-2% of the pancreas’ volume and secretes hormones that regulate most of the carbohydrate metabolism in the body ?

Answer 130

Endocrine Pancreas

Question 131

How much of the pancreas volume is made up of the endocrine pancreas?

Answer 131

1-2%

Question 132

What type of cells make up the endocrine pancreas?

Answer 132

islets of Langerhans

Question 133

The pancreatic islets (within the endocrine pancreas) are made up of what three cells?

Answer 133

alpha, beta, delta cells

Question 134

The Beta cells of the pancreatic islets (within the endocrine pancreas) secrete what two things?

Answer 134

insulin and amylin

Question 135

The Alpha cells of the pancreatic islets (within the endocrine pancreas) secrete what?

Answer 135

Glucagon

Question 136

The Delta cells of the pancreatic islets (within the endocrine pancreas) secrete what?

Answer 136

Somatostatin

Question 137

What is the only hormone to have a direct effect on lowering blood glucose levels?

Answer 137

Insulin

Question 138

It is important to understand the effects of insulin resistance in type 2 diabetes is one of the main pathophysiological features.

True or False?

Answer 138

True

Question 139

The active form of insulin is composed of what two (2) polypeptide chains?

Answer 139

A chain and B chain

Question 140

Active insulin is formed from what type of insulin?

Answer 140

pro-insulin

Question 141

What is pro-insulin composed of?

Answer 141

An active insulin and a (biologically inactive) connecting peptide

Question 142

The Structure of Pro-insulin

The A and B chain are joined by what?

Answer 142

the connecting peptide

Question 143

The Structure of Pro-insulin

The cleaving of the connecting peptide results in pro-insulin being converted to what?

Answer 143

insulin

Question 144

Both active insulin and inactive ___-_____________ _________ are packaged into ______________ ______________ and released from the beta cell at the same time.

Answer 144

C-Peptide Chain and secretory granules

Question 145

Both active insulin and inactive C-peptide chain are packaged into secretory granules and released from the beta cell at the opposite times.

True or False?

Answer 145

False (Both active insulin and inactive C-peptide chain are packaged into secretory granules and released from the beta cell at the same time)

Question 146

Clinically, it is impossible to measure serum C-peptide to assess beta cell function and the need for insulin therapy. Other methods must be used.

Answer 146

False (Clinically, it is possible to measure serum C-peptide to assess beta cell function and the need for insulin therapy.)

Question 147

Blood glucose enters the beta cell by means of what?

Answer 147

the glucose transporter

Question 148

Blood Glucose it is metabolized to form what through what process?

Answer 148

ATP (adenosine triphosphate) through phosphorylation

Question 149

Blood glucose enters the beta cell by means of the glucose transporter. It is metabolized to form adenosine triphosphate or ATP through phosphorylation by an enzyme called what?

Answer 149

glucokinase

Question 150

ATP from glucose is needed for what purpose in the beta cell?

Answer 150

close the K+ channels and depolarize the cell

Question 151

Once the beta cell is depolarized, which channels can open? What does this cause?

Answer 151

calcium channels and insulin secretion

Question 152

Is insulin secretion is decreased or increased when blood glucose levels are lower?

Answer 152

Decreased

Question 153

Is insulin secretion is decreased or increased when blood glucose levels are higher?

Answer 153

Increased

Question 154

Insulin response is known as what?

Answer 154

biphasic

Question 155

The first release of insulin peaking ____-_____ minutes post food ingestion and returning to baseline within ____-____ hours.

Answer 155

3-5 minutes and 2-3 hours

Question 156

What occurs during the first phase of insulin response?

Answer 156

stored performed insulin is secreted

Question 157

When does the second phase of insulin response occur and how long does it last?

Answer 157

around 2 minutes and continues to increase slowly for at least 60 minutes (or until the stimulus ceases)

Question 158

What is important about the insulin released during the second phase of insulin response?

Answer 158

insulin released is newly synthesized insulin

Question 159

Insulin has three main actions. What are they?

Study slide - Long response

Answer 159

1. Promotes uptake of glucose (by target cells) and increases glycogen synthesis.
2. Prevents fat and glycogen breakdown.
3. Inhibits gluconeogenesis and increases protein synthesis

Question 160

As plasma glucose increases, insulin is secreted by the beta cells of the pancreas and enters the what?

Answer 160

portal circulation (in the liver)

Question 161

Once the insulin enters the portal circulation in the liver, how much of it is used or degraded?

Answer 161

50%

Question 162

What is the half-life of insulin, once it is released into circulation?

Answer 162

approximately 15 minutes

Question 163

To initiate the effect on target tissue insulin binds to what?

Answer 163

a membrane receptor

Question 164

The membrane receptor on the target tissue is composed of two subunits known as?

Answer 164

Alpha Subunit and Beta Subunit

Question 165

Which subunit of the membrane receptor on the target tissue extends outside of the cell membrane? What occurs here?

Answer 165

Alpha Subunit and insulin binds

Question 166

Which subunit of the membrane receptor on the target tissue is predominately inside the cell membrane? What occurs here?

Answer 166

Beta Subunit and contains kinase enzyme (that activates with insulin binding)

Question 167

The beta subunit is predominately inside the cell membrane. This is smaller than the alpha unit and contains kinase enzyme that activates with insulin binding. What does this kinase enzyme result in?

Answer 167

autophosphorylation of the beta subunit (activates some enzymes and inactivates others)

Question 168

The beta subunit is predominately inside the cell membrane. This is smaller than the alpha unit and contains kinase enzyme that activates with insulin binding.
This kinase enzyme result in the autophosphorylation of the beta subunit which activates some enzymes and inactivates others. What does this cause?

Answer 168

(the desired intracellular effect of) insulin on glucose, fat and protein metabolism as well as cell growth.

Question 169

Specifically, what causes glucose transport, fatty acid synthesis, glycogen synthesis, cell growth and survival, and amino acid/electrolyte transport?

Answer 169

Insulin receptor substrates 1-4

Question 170

Cell membranes are almost completely permeable to glucose and therefore can move from the blood into the cell without a problem.

True or False?

Answer 170

False (Cell membranes are almost impermeable to glucose and therefore require a special carrier called a glucose transporter to move glucose from the blood into the cell. )

Question 171

What are the 3 types of glucose transporters discussed?

Answer 171

GLUT 4, 2, 1

Question 172

Which glucose transporter discussed is the insulin-dependent glucose transporter for skeletal muscle and adipose tissue?

Answer 172

GLUT-4

Question 173

What is GLUT-4 stimulated by? Where does it move from? (What does it do here?)

Answer 173

Stimulated by insulin to move from its inactive site to the cell membrane (where it facilitates glucose entry)

Question 174

Which glucose transporter discussed is the major transporter for glucose into beta cells and liver cells?

Answer 174

GLUT-2

Question 175

Which glucose transporter discussed present in all tissues and does not require the action of insulin. (Hint: It is important in the transport of glucose into cells of the nervous system)

Answer 175

GLUT-1

Question 176

All of these glucose transporters move glucose across the cell membrane at a faster rate than they would with diffusion alone.

True or False?

Answer 176

True

Question 177

Mitogen activated protein (MAP) kinase signaling cascade promotes what three things?

Answer 177

cell growth, cell differentiation, and gene expression

Question 178

What is released at the same time as insulin, by beta cells?

Answer 178

Amylin

Question 179

What is the job of Amylin?

Answer 179

It regulates blood sugar by having antihyperglycemic and satiety effects (by delaying nutrient uptake through inhibition of gastric emptying and suppressing glucagon secretion after meals.)

Question 180

What is a polypeptide molecule produced by the alpha cells and works opposite to insulin?

Answer 180

Glucagon

Question 181

Where does the glucagon travel to the liver via?

Answer 181

the portal circulation

Question 182

Where does glucagon exert its main function?

Answer 182

In the liver

Question 183

How does glucagon maintain blood sugar levels between meals?

Answer 183

by initiating glycogenolysis (in the liver,) and stimulating gluconeogenesis (increasing transport of amino acids into liver)

Question 184

When there are high levels of glucagon, glucagon activates what? What does this do?

Answer 184

Adipose cell lipase makes fatty acids available for use as an alternative source of energy

Question 185

Glucagon can also have an inotropic effect, enhance bile secretion and inhibit gastric acid secretion at high levels.

True or False?

Answer 185

True

Question 186

What is released by delta cells in the endocrine pancreas?

Answer 186

Somatostatin

Question 187

What stimulates somatostatin secretion?

Answer 187

Almost all aspects related to food ingestion

Question 188

What are the main two jobs of somatostatin?

Answer 188

decrease GI activity and inhibit release of insulin and glucagon

Question 189

What does somatostatin cause an extended time for?

Answer 189

food to be absorbed and will extend the use of absorbed nutrients by tissues

Question 190

What type of hormones counteract the storage functions of insulin in regulating the blood glucose levels during periods of fasting, exercise, and stress?

Answer 190

Counter-regulatory hormones

Question 191

There can be situations that can limit glucose intake, but not deplete glucose stores.

True or False?

Answer 191

False (There can be situations that either limit glucose intake or deplete glucose stores.)

Question 192

What is one of the catecholamines released by the adrenal medulla when stimulated by the sympathetic nervous system. (Hint: It is particularly active in the stress response.)

Answer 192

Epinephrine

Question 193

Epinephrine can cause ______________ ____________________ by promoting gluconeogenesis and glycogenolysis in the liver

Answer 193

transient hyperglycemia

Question 194

Epinephrine inhibits _____________ formation as well as increasing the breakdown of muscle __________________ stores

Answer 194

glycogen

Question 195

Epinephrine inhibits insulin release from beta cells which decreases glucose uptake in muscle and other organs. Why is this done?

Answer 195

This preserve glucose for the brain

Question 196

Glucose released by muscle glycogen is not released into the blood, however the ___________________ of these stores for muscle use conserves blood glucose for use by other tissues that rely almost solely on glucose for energy for what organ and what system?

Answer 196

mobilization and brain and nervous system

Question 197

What can stimulate lipolysis by freeing triglycerides and fatty acids from adipose tissue?

Answer 197

Epinephrine

Question 198

Epinephrine can also catalyze the degradation of circulating cholesterol to bile acids.

True or False?

Answer 198

False (It inhibits the degradation of circulating cholesterol to bile acids.)

Question 199

Which counter-regulatory hormone increases protein synthesis in all cells of the body, stimulates lipolysis and antagonizes the effects of insulin?

Answer 199

Growth Hormone (GH)

Question 200

Growth Hormone increases or decreases cellular uptake and use of glucose?

Answer 200

decreases

Question 201

What disease can result in glucose intolerance or the development of diabetes mellitus?

Answer 201

acromegaly (which is characterized by hypersecretion of growth hormone)

Question 202

For those with diabetes, an increase in growth hormone (which occurs in periods of stress and growth for children) can lead to the whole spectrum of what?

Answer 202

Metabolic Abnormalities (associated with poor regulation) (even though insulin treatment may be optimized)

Question 203

Which counter-regulatory hormone refer to steroid hormones that have direct effects on carbohydrate metabolism?

Answer 203

Glucocorticoids (specifically cortisol)

Question 204

Where are glucocorticoids (specifically cortisol) synthesized?

Answer 204

in the adrenal cortex

Question 205

One of the main effect of cortisol is to stimulate what?

Answer 205

gluconeogenesis

Question 206

Glucocorticoids also moderately decrease what?

Answer 206

the use of glucose by tissue.

Question 207

Outside of the liver, glucocorticoids stimulate what?

Answer 207

protein catabolism

Question 208

Outside of the liver, glucocorticoids inhibit what two things?

Answer 208

amino acid uptake and protein synthesis

Question 209

Increased cortisol complicates diabetes.

True or False?

Answer 209

TRUE

Question 210

Glucagon is not considered a counter-regulatory hormone.

True or False?

Answer 210

FALSE

Question 211

Counter-regulatory hormones play an essential role in glucose homeostasis especially in times of __________ and ____________________.

Answer 211

stress and hypoglycemia

Question 212

When there is persistent stress or hypersecretion of these hormones for other reasons, there are consequences which can lead to dysfunction of what?

Answer 212

glucose metabolism

Question 213

What is a metabolic disorder characterized by the presence of hyperglycemia (due to defective insulin secretion, defective insulin action or both) known as?

Answer 213

Diabetes Mellitus

Question 214

Diabetes Mellitus must have hyperglycemia due to what defects?

Answer 214

Defective insulin secretion, defective insulin action or both

Question 215

The chronic hyperglycemia of diabetes is associated with relatively specific longterm microvascular complications affecting the _________ , ___________ , ___________ as well as an increased risk for ___________________ ____________ (CVD)

Answer 215

eyes, kidneys, nerves, heart, and cardiovascular disease (CVD)

Question 216

Diagnostic criteria for diabetes are based on thresholds of ____________ associated with microvascular disease, especially __________________.

Answer 216

glycemia and retinopathy

Question 217

What is a qualitative term used to describe blood glucose (BG) that is abnormal without defining a threshold?

Answer 217

Dysglycemia

Question 218

The adoption of the term “dysglycemia) reflects uncertainty about optimal BG ranges and the current understanding that cardiovascular risk and mortality risk exist in people with even slightly elevated BG levels.

True or False?

Answer 218

True

Question 219

Type 1 diabetes is a catabolic disorder characterized by what three things?

Answer 219

Absolute lack of insulin, Hyperglycemia and a breakdown of fats and proteins (for energy instead of carbohydrates)

Question 220

The pathophysiology of type 1 diabetes, particularly the absolute lack of insulin, makes these patients prone to what?

Answer 220

ketoacidosis

Question 221

Type 1B Idiopathic Diabetes contains beta cell destruction; however no evidence of autoimmunity is present.

True or False?

Answer 221

TRUE

Question 222

What type of diabetes is an autoimmune disorder where genetics and an environmental triggering even cause a T-lymphocyte mediated hypersensitivity reaction against some beta cell antigen?

Answer 222

Type 1A

Question 223

Type 1A Autoimmune Diabetes

The destruction of beta cells is two-fold because:

1. First, there is __________________ and ___________________ infiltration of the islets which results in _________________ or insulitis and islet beta cell death.
2. Secondly, there is production of autoantibodies against islet cells, insulin, glutamic acid decarboxylase (GAD) and other cytoplasmic proteins.

(Glutamic acid decarboxylase is an enzyme in beta cells that is involved in glucagon synthesis.)

Answer 223

lymphocyte and macrophage and inflammation

Question 224

Type 1A Autoimmune Diabetes

The destruction of beta cells is two-fold because:

1. First, there is lymphocyte and macrophage infiltration of the islets which results in inflammation or insulitis and islet beta cell death.
2. Secondly, there is production of __________________ against islet cells, insulin, glutamic acid decarboxylase (GAD) and other cytoplasmic proteins.

(Glutamic acid decarboxylase is an ______________ in beta cells that is involved in glucagon synthesis.)

Answer 224

autoantibodies and enzyme

Question 225

Putting It Together: Type 1 Diabetes Mellitus

What two things cause autoantigens to form on insulin-producing beta cella and circulate in the blood stream and lymphatics?

Answer 225

genetic predisposition and environmental factors

Question 226

Putting It Together: Type 1 Diabetes Mellitus

What occurs as the autoantigens circulate through the body?

Answer 226

Processing and presentation of autoantigens

Question 227

Putting It Together: Type 1 Diabetes Mellitus

What are activated when circulating autoantigens are ingested by antigen-presenting cells?

Answer 227

T helper 1 lymphocytes

Question 228

T helper 1 lymphocytes secrete _______________ which activates _______________ and stimulates the release of inflammatory cytokines like IL-1 and TNF-alpha

Answer 228

interferon and macrophages

Question 229

T helper 1 lymphocytes secrete interferon which activates macrophages and stimulates the release of inflammatory cytokines like _____-___ and ______-________

Answer 229

IL-1 and TNF-alpha

Question 230

What do inflammatory cytokines such as IL-1 and TNF-alpha cause?

Answer 230

beta cell destruction and apoptosis

Question 231

Activated T helper 1 lymphocytes also secrete ________________ ____ which activates beta cell autoantigen-specific T lymphocytes.

Answer 231

interleukin 2

Question 232

Activated T helper 1 lymphocytes also secrete interleukin 2, which activates beta cell autoantigen-specific T lymphocytes.

This leads to the destruction of beta cells which results in what?

Answer 232

decreased insulin secretion

Question 233

Activation of T helper 2 lymphocytes causes the secretion of _________________-_____, which stimulates B lymphocytes to proliferate and produce antibodies.

Answer 233

interleukin-4

Question 234

Activation of T helper 2 lymphocytes causes the secretion of interleukin-4, which stimulates B lymphocytes to do what two things?

Answer 234

proliferate and produce antibodies

Question 235

Activation of T helper 2 lymphocytes causes the secretion of interleukin-4, which stimulates B lymphocytes to proliferate and produce antibodies.

These autoantibodies contribute to the destruction of beta cells and decreased insulin secretion.

Answer 235

True

Question 236

Putting It Together: Type 1 Diabetes Mellitus

There is dysfunction in both ____________ and _________-____________________ immunity.

Answer 236

humoral and cell-mediated immunity

Question 237

Putting It Together: Type 1 Diabetes Mellitus

Remember that T regulatory cells usually act to inhibit the immune response. There have been mutations affecting these cells noted in a rare form of diabetes called _____________ ________________.

Further research is needed to investigate the role or lack-there-of, of T regulatory cells.

Answer 237

neonatal diabetes

Question 238

Like type 1 diabetes, there is a genetic predisposition as well as environmental influences that result in the basic pathophysiologic mechanisms of what type of diabetes?

Answer 238

type 2

Question 239

Like type 1 diabetes, there is a genetic predisposition as well as environmental influences that result in the basic pathophysiologic mechanisms of what type of diabetes?

Answer 239

type 2

Question 240

Like type 1 diabetes, there is a genetic predisposition as well as environmental influences that result in the basic pathophysiologic mechanisms of diabetes type 2.

These include insulin resistance, abnormal insulin secretion beta cells and increased glucose production by the liver.

True or False?

Answer 240

TRUE

Question 241

Many genes have been identified as being associated with type 2 diabetes.

Which of the following are coded for by genes?

a) beta cell mass
b) beta cell function
c) proinsulin and insulin molecular structure
d) insulin receptors, hepatic synthesis of glucose
e) glucagon synthesis
f) cellular responsiveness to insulin stimulation
g) All of the above

Answer 241

G

Question 242

A relative insulin deficiency is required to develop what type of diabetes?

Answer 242

type 2 diabetes

Question 243

Beta cell dysfunction is always present in some extent with type 2 diabetes.

True or False?

Answer 243

True

Question 244

Many individuals have risk factors for type 2 diabetes including: obesity, metabolic syndrome and hypertension and are insulin resistant.

However, it is only those who are ________________ ________________ to beta cell dysfunction who will develop type 2 diabetes.

Answer 244

genetically predisposed

Question 245

What prevents the clinical appearance of diabetes for many years?

Answer 245

Compensatory hyperinsulinemia (caused by insulin resistance)

Question 246

Eventually beta cell dysfunction leads to a relative insulin deficiency, hyperglycemia, and type 2 diabetes.

True or False?

Answer 246

true

Question 247

What causes a relative insulin deficiency in type 2 diabetes?

Answer 247

Beta cell dysfunction

Question 248

Beta cell dysfunction may be a result of what three things?

Answer 248

Decrease in beta cell mass, abnormal function of beta cells, or some combination of these.

Question 249

With beta cell dysfunction, there is progressive decrease in the ________ and ___________ of beta cells.

Answer 249

weight and number

Question 250

Beta cells are extremely sensitive to high levels what two substances?

Answer 250

Glucose and free fatty acids

Question 251

Beta cells are extremely sensitive to high levels of glucose and free fatty acids and undergo apoptotic death in what type of conditions?

Answer 251

glucolipotoxic conditions

Question 252

Adipokine __________ decreases insulin synthesis in beta cell.

Answer 252

leptin

Question 253

Inflammatory cytokines like ______-______ and _____-________ which are released from adipocytes, are toxic to beta cells.

Answer 253

TNF-alpha and IL-beta

Question 254

Beta cell exhaustion from increased demand for insulin biosynthesis which is associated with intracellular oxidative stress and endoplasmic reticulum dysfunction.

True or False?

Answer 254

true

Question 255

What is the suboptimal response of insulin-sensitive tissues to insulin?

Answer 255

Insulin Resistance

Question 256

What are three insulin-sensitive tissues?

Answer 256

Liver, muscle and adipose tissue.

Question 257

The mechanisms of insulin resistance include:

a) an abnormality of the insulin molecule
b) high amounts of insulin receptor
c) decreased or abnormal activation of postreceptor kinases
d) alteration of glucose transporter proteins
e) All of the above

Answer 257

E

Question 258

What is present in 60-80% of individuals with type 2 diabetes?

Answer 258

obesity

Question 259

What percentage of those with type 2 diabetes are overweight?

Answer 259

90%

Question 260

Obesity is a significant contributor to both _________ ________________ and ________ __________ _____________________.

Answer 260

insulin resistance and beta cell dysfunction

Question 261

Obesity is a significant contributor to both insulin resistance and beta cell dysfunction.

Increased ________________ (hormones produced in adipose tissues) and expression of a receptor called peroxisome proliferator-activated receptor gamma which is highly expressed in adipose tissue and responsible for the changes in ____________________.

Answer 261

adipokines

Question 262

Obesity is a significant contributor to both insulin resistance and beta cell dysfunction.

This includes Increased levels of serum leptin and resistin and decreased levels of adiponectin; adiponectin increases tissue sensitivity to insulin and appears to have what three types of effects?

Answer 262

antidiabetic, anti-inflammatory and antiatherogenic effects.

Question 263

Which class of drugs modulate the activity of peroxisome proliferator-activated receptor gamma and are used to treat type 2 diabetes?

Answer 263

TZDs (thiazolidinediones)

Question 264

Elevated serum FFAs, intracellular deposits of ____________________ and ____________________ interfere with intracellular insulin signaling and decrease tissue response to insulin.

Answer 264

triglycerides and cholesterol

Question 265

What does Lipotoxcitiy causes within the beta cells?

Answer 265

altered insulin secretion

Question 266

Elevated FFAs inhibit what two things?

Hint: They cause insulin resistance and glucose underutilization

Answer 266

glucose uptake and glycogen storage (in the peripheral tissues)

Question 267

Elevated FFAs inhibit glucose uptake and glycogen storage in the peripheral tissues causing what two things?

Answer 267

insulin resistance and glucose underutilization

Question 268

Elevation of FFAs and triglycerides reduces what?

Hint: This leads to increases hepatic glucose production and hyperglycemia. This is heightened in the fasting state.

Answer 268

hepatic insulin sensitivity

Question 269

Elevation of FFAs and triglycerides reduces hepatic insulin sensitivity, leading to what two things?

Answer 269

increases hepatic glucose production and hyperglycemia. (This is heightened in the fasting state.)

Question 270

Inflammatory cytokines (like TNF-alpha and IL-6) are released from adipocytes and contribute to insulin resistance through what?

Answer 270

postreceptor mechanism

Question 271

Obesity is correlated with what two things?

Answer 271

hyperinsulinemia and decreased receptor density

Question 272

In a joint statement between the American Diabetes Association and the European Association for the Study of Diabetes, what is described as:

“a clustering of specific cardiovascular disease risk factors whose underlying pathophysiology is thought to be related to insulin resistance”

Answer 272

metabolic syndrome

Question 273

What seems seems to play a role in not only the pathophysiology of type 2 diabetes, but other metabolic abnormalities as well?

(This includes:

• obesity
• high levels of plasma triglycerides and low levels of high density lipoproteins (HDL)
• hypertension
• systemic inflammation detected by measuring plasma CRP and other inflammatory mediators
• abnormal fibrinolysis
• abnormal function of the vascular endothelium and macrovascular disease such as coronary artery, cerebrovascular and peripheral artery disease.)

Answer 273

insulin resistance

Question 274

Practitioners are cautioned to treat the patient based on whether they meet criteria for metabolic syndrome and not to evaluate and treat each cardiovascular disease risk factor independently of a metabolic syndrome diagnosis.

True or False?

Answer 274

False (Practitioners are cautioned to not treat the patient based on whether they meet criteria for metabolic syndrome but to evaluate and treat each cardiovascular disease risk factor independently of a metabolic syndrome diagnosis.)

Question 275

There is a universal consensus on metabolic syndrome criteria. It’s world renowned.

Answer 275

False (There is no universal consensus on metabolic syndrome criteria.)

Question 276

The World Health Organization and International Diabetes Federation have outlined criteria where what was a requisite?

Answer 276

insulin resistance

Question 277

The criteria are outlined in the Canadian Diabetes Association Clinical Practice Guidelines provide an operational definition based on _______ _________________ and is intended to be used to ensure consistency in North American clinical practice when diagnosing metabolic syndrome.

Answer 277

risk determinants

Question 278

Metabolic Syndrome is diagnosed when the patient meets three (3) or more of the following criteria:

• Abdominal Obesity: waist circumference ≥ 88 cm in women or ≥ 102 cm in men
• Triglycerides: ≥ 1.7 mmol/L
• HDL: < 1.3 mmol/L in women or < 1.0 mmol/L in men
• Blood Pressure: ≥ 130 systolic or ≥ 85 mmHg diastolic
• Fasting Plasma Glucose ≥ 5.6 mmol/L

True or False?

Answer 278

True

Question 279

Insulin resistance and metabolic syndrome are associated and the associated cardiovascular risks must each be evaluated and treated either within the treated either within the context of a type 2 diabetes diagnosis or not.

True or False?

Answer 279

True

Question 280

What three things leads to obesity?

Answer 280

Diet, inactivity, and genetic predisposition

Question 281

Obesity causes derangement of ______________, increased ____________ ___________ _________ and release of ____________________ ______________ from adipocytes.

Answer 281

adipokines, increased free fatty acids and release of inflammatory cytokines

Question 282

When there is resistance to insulin, the demand for insulin synthesis increases leading to what?

Answer 282

hyperinsulinemia

Question 283

When there is resistance to insulin, the demand for insulin synthesis increases, leading to hyperinsulinemia.

• The clinical appearance of diabetes is avoided for many years due to compensatory hyperinsulinemia.

-The result is damaging tissue effects without hyperglycemia or insulin resistance without diabetes.
Remember, that these

Individuals often meet criteria for ________________ _______________ and should be treated accordingly.

Answer 283

metabolic syndrome

Question 284

Genetic predisposition to beta cell dysfunction leads to what?

Answer 284

hypoinsulinemia

Question 285

Insulin resistance causes an increased demand for what?

Answer 285

insulin synthesis

Question 286

Beta cell exhaustion is associated with what two things? What does this lead to?

Answer 286

Intracellular oxidative stress and endoplasmic reticulum dysfunction, leading to beta cell apoptosis.

Question 287

What two things have a direct toxic effect to beta cells?

Answer 287

Lipotoxic conditions and inflammatory cytokines

Question 288

Normally, glucagon release is inhibited by what?

Answer 288

hyperglycemia

Question 289

Pancreatic alpha cells are less responsive to glucose inhibition in type 2 diabetes causing what?

Answer 289

increased glucagon secretion (and contributing to hyperglycemia)

Question 290

Decreased amylin activity parallels the reduction in insulin secretion.

True or False?

Answer 290

True

Question 291

Amyloid deposition in the pancreas, does not contribute to islet cell dysfunction.

Answer 291

False (Amyloid deposition in the pancreas which contributes to islet cell dysfunction. )

Question 292

Amylin normally inhibits what?

Answer 292

glucagon secretion

Question 293

What are peptides released in the GI tract when food is ingested?

Answer 293

Incretin

Question 294

What is the job of incretin after it binds to receptors on beta cells?

Answer 294

increase the synthesis and secretion of insulin (in response to glucose levels)

Question 295

In type 2 diabetes, is incretin activity increased or decreased?

Answer 295

Decreased (which impairs beta cell function)

Question 296

There are drugs approved in the US aimed at augmenting one of the incretin peptides and inhibiting an enzyme that inactivates them.

True or False?

Answer 296

True

Question 297

What is the peptide produced in the stomach and pancreatic islets that stimulates growth hormone secretion and is involved in homeostasis regulation of energy, glucose, GI motility and secretion?

(HINT: this is often termed the ‘hunger hormone’ because it stimulates appetite, increases food intake and promotes fat storage.)

Answer 297

Ghrelin

Question 298

What 3 things is ghrelin involved in homeostasis regulation of?

Answer 298

energy, glucose, GI motility and secretion.

Question 299

Ghrelin has an effect on insulin however the effect is unclear.

True or False?

Answer 299

True

Question 300

Although the effect ghrelin has on insulin, is unclear. Decreased levels of circulating ghrelin have been associated with what two things?

Answer 300

insulin resistance and increased fasting insulin levels

Question 301

Counter Regulatory Mechanisms in Diabetes Mellitus

What Effect or Phenomenon is characterized by insulin by insulin induced hypoglycemia followed by rebound hyperglycemia?

Answer 301

Somogyi Effect

Question 302

Counter Regulatory Mechanisms in Diabetes Mellitus - Somogyi Effect

The cycle occurs when hyperglycemia and insulin resistance is treated with larger insulin doses.

The hypoglycemia state stimulates which 4 glucose counter-regulatory hormones?

redistributing dietary carbohydrates and altering insulin dose (or time of administration.)

Answer 302

cathecholamines, glucagon, cortisol and growth hormone

Question 303

Counter Regulatory Mechanisms in Diabetes Mellitus - Somogyi Effect

Management to prevent hypoglycemia and subsequent counter-regulatory mechanisms activation includes what two things?

Answer 303

redistributing dietary carbohydrates and altering insulin dose (or time of administration.)

Question 304

Somogyi effect usually occurs in which type of diabetes?

Answer 304

Type 1

Question 305

Somogyi effect usually cannot occur at all in type 2 diabetes.

True or False?

Answer 305

False (Somogyi effect usually occurs in type 1 diabetes however it can occur in type 2 diabetes if insulin is prescribed.)

Question 306

Counter Regulatory Mechanisms in Diabetes Mellitus

What Effect or Phenomenon is characterized by hyperglycemia between 0500-0900 without preceding hypoglycemia?

Answer 306

Dawn Phenomenon

Question 307

Counter Regulatory Mechanisms in Diabetes Mellitus - Dawn Phenomenon

One possible cause is that there is a change in the normal _____________ ________________ for glucose tolerance in diabetes.

Answer 307

circadian rhythm

Question 308

Counter Regulatory Mechanisms in Diabetes Mellitus - Dawn Phenomenon

Which of the following Statement(s) are/is correct?

A) Glucose is normally higher during the later part of the morning.
B) It also appears to be related to daytime elevations of growth hormone.
C) Management includes altering the time and dose of glucagon.

Answer 308

A

Question 309

Are the following acute or chronic complications of diabetes?

• Hypoglycemia
• diabetic ketoacidosis
• hyperosmolar hyperglycemic nonketotic syndrome

Answer 309

Acute Complications

Question 310

Can acute or chronic complications can be classified either microvascular or macrovascular disease?

Answer 310

chronic complications

Question 311

Chronic Complications can be classified microvascular or macrovascular disease.

Which type includes retinopathy, neuropathy, and nephropathy?

Answer 311

Microvascular disease

Question 312

Chronic Complications can be classified microvascular or macrovascular disease.

Which type includes coronary artery disease, cerebrovascular disease and peripheral vascular disease?

Answer 312

Macrovascular disease

Question 313

Both type 1 and 2 diabetes evolve over time eventually to a point where there is either a relative or absolute deficiency of insulin which results in some common clinical manifestations.

True or False?

Answer 313

True

Question 314

What term means excessive urination?

Answer 314

polyuria

Question 315

Why does polyuria occur?

Answer 315

the amount of glucose (filtered by the glomeruli of the kidneys) exceeds that which can be reabsorbed by the renal tubules (and glucose acts as an osmotic diuretic.)

Question 316

What term means excessive thirst?

Answer 316

Polydipsia

Question 317

Why does Polydipsia occur?

Answer 317

hyperglycemia pulls water out of body cells (intracellular dehydration, occurs) (Furthermore, polyuria contributes to a state of dehydration.)

Question 318

What term means excessive hunger?

Answer 318

polyphagia

Question 319

Polyphagia: which means excessive hunger, usually does NOT occur in type 1 diabetics.

True or False?

Answer 319

False (Occurs in type 1 diabetes, not type 2)

Question 320

Why does Polydipsia occur?

Answer 320

(In type 1 diabetes, it is the result of cellular starvation) The depletion of cellular stores of carbohydrates, fats, and proteins. (This depletion corresponds with increased hunger.)

Question 321

Despite normal or increased appetite, weight loss is common in uncontrolled type 1 or 2 diabetes?

Answer 321

Type 1

Question 322

Why does weight loss occur in Type 1 Diabetes Mellitus?

The loss of fluid through osmotic diuresis and vomiting during periods of ketoacidosis (this may exaggerate the weight loss due to fluid loss)

The absolute insulin deficiency leads to the loss of body tissue as fat and proteins are used for energy as a result of insulin deficiency

True or False?

Answer 322

True

Question 323

Which type of diabetes is seen with obesity?

Answer 323

Type 2

Question 324

Genetics may have a role in obesity; however lifestyle and nutrition contribute significantly.

True or False?

Answer 324

True

Question 325

What can occur as with exposure of the lens and retina to hyperosmolar fluids?

Answer 325

Blurred Vision

Question 326

What is the result of lowered plasma volume, poor use of food products due to metabolic changes and possibly sleep loss from severe nocturia?

Answer 326

Fatigue

Question 327

What can occur due to dysfunction of the peripheral sensory nerves called peripheral vascular disease?

Answer 327

Paresthesias

Question 328

What can occur due to injury in person with peripheral vascular disease that was not attended to?

(Candida or yeast infections are common causes of vulvovaginitis and balanitis.)

Answer 328

Infections

Question 329

Signs and symptoms related to diabetes will be heightened in individuals whose blood sugar is not managed well.

True or False?

Answer 329

True

Question 330

What is the preferred diagnostic test for diabetes?

Answer 330

fasting blood glucose (FBG)

Question 331

The fasting blood glucose (FBG) requires that the individual fast for at least ___ hours?

Answer 331

8

Question 332

Diagnosis of diabetes is made when the FBG be ≥ 7.0 mmol/L on 2 occasions *if asymptomatic.

True or False?

Answer 332

True

Question 333

Which Diabetes Diagnostic Test can be done without regard to time or last meal?

Answer 333

Random Blood Glucose Test

Question 334

Random Blood Glucose Test

A finding of greater than 11.1 mmol/L and classical clinical manifestations of diabetes like polyuria, polydipsia and unexplained weight loss, meets the criteria for the diagnosis of what?

Answer 334

Diabetes

Question 335

Which Diabetes Diagnostic Test measures plasma glucose response to 75 g concentrated glucose solution at 2 hours post glucose load?

(A diagnosis of diabetes mellitus is made for a finding of ≥ 11.1 mmol/L.)

Answer 335

Oral Glucose Tolerance Test (OGTT)

Question 336

What test measures the proportion of glycated hemoglobin in circulation?

Answer 336

Glycated Hemoglobin or A1C Test

Question 337

What does Glycated Hemoglobin or A1C Test measure?

Answer 337

average plasma glucose concentration over the past 2 to 3 months.

Question 338

When can the Glycated Hemoglobin or A1C Test be taken?

Diagnosis of diabetes mellitus is made for a finding of ≥ 6.5% glycated hemoglobin

Answer 338

at any time of the day (and avoids the problem of day-to-day variations in plasma glucose levels)

Question 339

What is the gold standard for monitoring diabetes at home?

Answer 339

Capillary Blood Glucose Monitoring

Question 340

What uses capillary blood from pricking the finger or forearm, then the blood is placed on the reagent strip and the strip is entered into the glucometer to determine capillary blood glucose?

Answer 340

Capillary Blood Glucose Monitoring

Question 341

Capillary Blood Glucose Monitoring

What type of blood is used?

(Which gives results that are 10-15% lower than when plasma is used in laboratory tests)

Answer 341

Whole Blood

Question 342

Newer glucometers can be calibrated to give plasma values?

True or False?

Answer 342

True

Question 343

Hemoglobin A1C has become part of the standard of care in the management of diabetes. What is the goal % that is outlined in the Canadian Diabetes Association clinical practice guidelines.

Answer 343

less than 7%

Question 344

Hemoglobin A1C

Hemoglobin requires insulin for glucose entry into red blood cells.

True or False?

Answer 344

False (Hemoglobin A1C)

Question 345

Hemoglobin A1C

The rate at which glucose becomes attached to hemoglobin is dependent on what?

Answer 345

blood glucose levels

Question 346

Hemoglobin A1C

During RBCs _______ day life span, they become glycated to form A1a and A1b and A1C.

Answer 346

120

Question 347

Hemoglobin A1C

Glycosylation of hemoglobin is essentially irreversible/reversible?

Answer 347

Irreversible (and individuals with hyperglycemia will have a higher percentage of glycosylated hemoglobin.)

Question 348

Hgb A1C is found to be useful in screening for what two things?

Answer 348

chronic hyperglycemia and assessing the effectiveness of therapy

Question 349

What can be used to measure glucose or ketones?

Answer 349

Urine Tests

Question 350

In uncontrolled diabetes, hyperglycemia will persist and when the renal threshold for glucose reabsorption is reached, what ensues?

Answer 350

glycosuria ensues

Question 351

What are the metabolic end-products of fat metabolism?

Answer 351

Ketones

Question 352

Normally, ketones are completely metabolized but when fat metabolism is the predominant source of energy, excessive amounts of ketones are formed and excreted through the urine. This occurs when?

Answer 352

In diabetic ketoacidosis.

Question 353

Genetic Studies and testing for plasma Antibodies specific to diabetes can be done in certain circumstances.

True or False?

Answer 353

True

Question 354

Insulin therapy is required in the management of type 1 diabetes and many people with type 2 diabetes will eventually require some sort of insulin therapy.

True or False?

Answer 354

True

Question 355

Insulin can be administered by what two methdods?

Answer 355

injection or inhalation

Question 356

Which injection routes are used for Insulin Therapy?

Answer 356

subcutaneous and intravenous

Question 357

Where is intravenous insulin therapy used?

Answer 357

in the hospital setting (only regular insulin can be given intravenously)

Question 358

Regular insulin can bind to plastic IV tubing and therefore the insulin solution is often run through the tubing for a period of time before attaching to patient.

Answer 358

True

Question 359

Inhaled Insulin is NOT approved and used in Canada.

True or False?

Answer 359

False (It is; but not commercially available yet)

Question 360

Inhaled Insulin was used as a rapid-acting insulin in combination with 1 or 2 SC injections of ________-______________ insulin doses.

The study results are promising, finding that in adults’ equivalent glycemic control was achieved with reduced fasting plasma glucose levels and increased patient satisfaction.

Answer 360

long-acting

Question 361

Inhaled Insulin

The short-term safety data suggest no significant pulmonary dysfunction; however, it is recommended that it not be used in patients with what?

Answer 361

abnormal baseline spirometry

Question 362

Insulin is destroyed in the GI tract and therefore cannot be given by what route?

Answer 362

orally

Question 363

Insulin preparations are primarily produced by what? What is the preparations called?

Answer 363

recombinant DNA technology (to be identical to human insulin or modified to alter pharmacokinetics) and insulin analogues.

Question 364

The Diabetes Control and Complications Trial (DCCT) concluded that intensive treatment of type 1 diabetes through the following, significantly delayed the onset and slowed the progression of microvascular and macrovascular complications.

• Basal/Bolus insulin regimens or continuous subcutaneous insulin infusion
• CBG Checks
• Meal Planning

True or False?

Answer 364

True

Question 365

An intermediate acting or long-acting insulin analogue given once or twice daily provides what type of insulin?

Answer 365

basal insulin

Question 366

A short-acting or rapid-acting insulin analogue given at each meal provides what type of insulin?

Answer 366

bolus (or prandial) insulin

Question 367

For continuous subcutaneous insulin infusion insulin aspart and lispro, both rapid-acting insulin analogues, were shown to be superior to regular insulin by improving post-prandial glycemic control and reducing hypoglycemia.

True or False?

Answer 367

True

Question 368

What is a major obstacle for achieving glycemic targets?

Answer 368

Hypoglycemia

Question 369

Hypoglycemia can only have negative physical consequences such as confusion, coma, or seizure. No social consequences.

True or False?

Answer 369

False (It can have negative social and emotional impacts as well as significant physical consequences such as confusion, coma, or seizure.)

Question 370

The health care team will work diligently with the diabetic to provide the safest insulin therapy to achieve the safest insulin therapy to achieve the best glycemic target.

True or False?

Answer 370

TRUE

Question 371

Any individual prescribed insulin therapy should be taught how to care and use of insulin; the prevention, recognition and treatment of hypoglycemia; what to do when they are sick; how to make adjustments for food intake and physical activity; and how to perform CBG monitoring.

True or False?

Answer 371

TRUE

Question 372

What are the two types of rapid-acting insulin called?

Answer 372

lispro (Humalog)
and aspart (Novolog)

Question 373

What is the onset of lispro (Humalog)
and aspart (Novolog)?

Answer 373

5-15 minutes

Question 374

What is the onset of regular insulin?

Answer 374

0.5-1 hour

Question 375

Pharmacologic Therapy - Oral Antidiabetic Agents

What are the two types of Insulin Secretagogues?

Answer 375

sulfonylurea and nonsulfonylurea agents

Question 376

Pharmacologic Therapy - Oral Antidiabetic Agents

Which part of an Insulin Secretagogue acts by binding to sulfonylurea receptor on the beta cell, which is linked to ATP sensitive K+ channel. (This causes the K+ channel to close and depolarization to occur.)

Answer 376

Sulfonylureas

Question 377

Pharmacologic Therapy - Oral Antidiabetic Agents

Which part of an Insulin Secretagogue acts by requiring glucose to close ATP-dependent K+ channel and subsequent insulin release through the same mechanisms as the sulfonylurea agents?

Answer 377

Nonsulfonylurea

Question 378

What can Insulin secretagogues cause if uneducated?

Answer 378

hypoglycemia (to avoid, recognize and manage hypoglycemic episodes)

Question 379

Pharmacologic Therapy - Oral Antidiabetic Agents

Which medication inhibits hepatic glucose production and increase the insulin sensitivity peripheral tissues?

What is the only one on the market in Canada?

Answer 379

Biguanides and Metformin

Question 380

Pharmacologic Therapy - Oral Antidiabetic Agents

Which medications are used when insulin secretagogues or Metformin is not effective in decreasing postprandial hyperglycemia?

Answer 380

Alpha-Glucosidase Inhibitors

Question 381

Pharmacologic Therapy - Oral Antidiabetic Agents

Alpha-Glucosidase Inhibitors

Alpha-Glucosidase is an enzyme that breaks down what in the small intestine?

Answer 381

Complex Carbohydrates

Question 382

Pharmacologic Therapy - Oral Antidiabetic Agents

Alpha-Glucosidase Inhibitors

By inhibiting this enzyme, the breakdown of complex carbohydrates is delayed thus blunting what?

Answer 382

the postprandial increase in plasma glucose and insulin levels

Question 383

Pharmacologic Therapy - Oral Antidiabetic Agents

Alpha-Glucosidase Inhibitors

Hypoglycemia can occur when alpha-glucosidase inhibitors are used in conjunction with sulfonylurea agent. If it does occur, glucose (which is dextrose, not sucrose or table sugar) should be used as sucrose breakdown may be blocked by the action of alpha-glucosidase inhibitors.

True or False?

Answer 383

True

Question 384

Pharmacologic Therapy - Oral Antidiabetic Agents

Which medications promote the activity of incretins by inhibiting dipeptidyl pepitidase-4 enzyme, which degrades the main incretins GLP-1 and glucose-dependent insulinotropic polypeptide?

(Remember that these incretins are released following a meal and stimulate insulin secretion from the beta cell.)

Answer 384

DPP (Dipeptidyl Peptidase)-4 Inhibitor

Question 385

Pharmacologic Therapy - Oral Antidiabetic Agents

Which medications • modulate the activity of peroxisome proliferator-activated receptor gamma specifically increasing adipocyte production of adiponectin and are the only class of drugs that target insulin resistance?

Answer 385

TZDs (thiazolidinediones)

Question 386

Pharmacologic Therapy - Oral Antidiabetic Agents

TZDs

They target insulin resistance by binding to the nuclear peroxisome proliferator-activated receptor gamma that is highly expressed in adipose tissue and seems to be responsible for the changes in adipokines in type 2 diabetes.

True or False?

Answer 386

TRUE

Question 387

Pharmacologic Therapy - Oral Antidiabetic Agents

TZDs

Changes include increased levels of serum leptin and resistin and more importantly decreased levels of what?

Answer 387

adiponectin

Question 388

Pharmacologic Therapy - Oral Antidiabetic Agents

TZDs

What increases tissue sensitivity to insulin and appears to have antidiabetic, anti-inflammatory and antiatherogenic effects?

Answer 388

adiponectin

Question 389

The mechanism of Thiazolidinedione is complex and not entirely understood however other beneficial effects include a decrease in FFA and triglycerides, blood pressure, inflammatory mediators like fibrinogen and CRP and procoagulation factors.

True or False?

Answer 389

TRUE

Question 390

Which medications can be used as an adjunct pharmacology therapy to lose weight in the management of type 2 diabetes mellitus?

Answer 390

Orlistat (or sibutramine) (Weight loss agents)

Question 391

Incretins and Amylin analogs are not available in Canada and were not discussed.

True or False?

Answer 391

True

Question 392

What are the 5 main components in patient teaching for diabetes?

Answer 392

Lifestyle (physical activity, smoking cessation, self-monitoring of blood glucose should be promoted)

Nutrition and diet (adjusting the components of carbohydrates, fat, and protein as required),

Education Regarding Medications (insulin and oral antidiabetic agents)

Avoiding/Recognizing Complications (including both acute and chronic complications will decrease mortality and morbidity and hopefully increase quality of life.)

Equipment (including the use and cost of can be a significant part of teaching. This includes but is not limited to teaching for subcutaneous injections, self-monitoring of blood glucose using capillary poke and glucometer an insulin pumps.)

Multi-disciplinary or Inter-Professional Team
What are the 5 main components in patient teaching for diabetes?

Question 393

Diabetes carriers no significant personal or societal burden.

True or False?

Answer 393

False (Diabetes carriers a significant personal and societal burden)

Question 394

Heterogenous and diverse groups require individualized treatments plans.

True or False?

Answer 394

True

Question 395

As obesity rates continue to climb, type 2 diabetes rates will decrease.

True or False?

Answer 395

False (As obesity rates continue to climb, type 2 diabetes rates will also increase.)

Question 396

Multiple co-morbidities in diabetes

True or False?

Answer 396

TRUE

Question 397

Decrease in complications IF glucose levels remain near normal levels of Hgb A1C, which are?

Answer 397

Less than 7%

Question 398

FROM TUTORIAL:

Definition of metabolic syndrome Includes:

• Elevated waist circumference
• Elevated Trigycerides
• Reduced HDL
• Elevated Blood Pressure
• Elevated Fasting blood glucose
• Elevated Visceral Fat

True or False?

Answer 398

False (Visceral fat is more related to diabetes (stomach versus more pear shaped))

Question 399

FROM TUTORIAL:

Diabetes is defined as:

A) A disorder characterized by excessive blood glucose levels
B) A disorder of carbohydrate, protein and fat metabolism
C) A disorder characterized by excessive urination
D) A disorder of dysfunctional counter regulatory hormones

Answer 399

C

Question 400

FROM TUTORIAL:

Which of the following complications accounts for most deaths in those with DM?

A) Coronary artery disease and stroke
B) Renal disease (nephropathy)
C) Erectile dysfunction
D) Non-traumatic amputation

Answer 400

A

Question 401

FROM TUTORIAL:

Which of the following is NOT an environmental factor contributing to an increased risk for Type I DM?

A) Use of pentamidine - an antimicrobial
B) Dietary intake of bovine milk
C) Congenital rubella infection
D) Infection with human papillomavirus

Answer 401

D

Question 402

FROM TUTORIAL:

Adult patients that develop DM as a result of latent autoimmune disease are best classified as:

A) Type 1A diabetics
B) Type 1B diabetics
C) Type 2 diabetics
D) Adult onset diabetics

Answer 402

A

Question 403

FROM TUTORIAL:

Which of the following is an endocrinopathy that may contribute to Type 2 DM?

A) Adrenal insufficiency
B) Overproduction of hGH
C) ADH insufficiency
D) Aldosteronism

Answer 403

B

Question 404

FROM TUTORIAL:

Which of the following clinical manifestations is predominantly observed in Type 1 DM but not Type 2 DM?

A) Polyuria (excessive urination)
B) Polydipsia (excessive thirst)
C) Polyphagia (excessive hunger)
D) Paresthesia (abnormal dermal sensation (e.g., a tingling, pricking, chilling, burning, or numb sensation on the skin) damage to peripheral nerves)

Answer 404

c

Question 405

FROM TUTORIAL:

What is the preferred test for diagnosing DM?

A) Fasting blood glucose
B) Random blood glucose
C) Oral glucose tolerance test (T2)
D) Insulin tolerance test

Answer 405

A

Question 406

FROM TUTORIAL:

What is the mechanism of action of the class of oral anti-diabetics known as thiazolidinediones (TZDs)?

A) They stimulate the secretion of insulin from pancreatic beta-cells
B) They inhibit hepatic glucose production
C) They delay the breakdown of complex carbs in the gut, thereby regulating glucose absorption
D) They modulate PPAR-gamma signalling in adipocytes, resulting in increased production of adiponectin
E) They inhibit dipeptyidyl peptidase, thereby preventing the breakdown of incretins

Answer 406

D

Question 407

FROM TUTORIAL:

Why is acquiring insulin paramount to ensuring Carl’s (A Type 1 Diabetic) survival?

A) Without insulin Carl may suffer the complications of severe hypoglycemia
B) Carl may experience beta-cell exhaustion and pancreatic destruction if exogenous insulin is not provided immediately
C) Carl’s pancreas may fail and he will be unable to secrete the enzymes necessary to break down the food stuffs in his gut
D) Carl may suffer severe weight loss due to protein catabolism, diuresis and emesis, and will not be able to defend himself from zombies

Answer 407

d

Question 408

FROM TUTORIAL:

Which of the following fuel sources packs the most energy per gram?

A) Triglycerides (fats)
B) Glucose
C) Proteins
D) Amino acids

Answer 408

a

Question 409

FROM TUTORIAL:

Which of the following events is thought to contribute to the development of Type 1A DM?

A) Secretion of IL-1 and TNF-α by macrophages, creating a pro-inflammatory environment
B) Secretion of IL-2 by TH1 cells, which activates autoreactive CD8+ T-cells
C) Secretion of IL-4 by TH2 cells, which activates B-cells that produce autoantibodies
D) Relative inactivity of regulatory T-cells that normally inhibit autoimmune responses
E) All of the above can contribute to Type 1A DM

Answer 409

e

Question 410

FROM TUTORIAL:

Symptoms of Hypoglycemia - usually seen in type 1.

Overshooting the insulin
(glucose <4 mmol/L)

Headache
Blurred vision
Hunger
Irritability
Anxiety
Diaphoresis
Dizziness
Tachycardia
Shaking (tremor)
Weakness
Fatigue
Feeling tired

True or False?

Answer 410

true

Question 411

FROM TUTORIAL:

What is the normal value for blood glucose 2-hr post prandial?

Answer 411

(5.0-8.0 mmol/L)

Question 412

Random Blood Glucose levels should be

Answer 412

no greater than 11.1

- without regard to last meal or time

Question 413

Oral glucose tolerance test levels

Answer 413

• no greater than 11.1 for diagnosis

Question 414

Glycated hemoglobin or A1C test levels

Answer 414

no greater than 6.5

Question 415

Impaired fasting blood glucose ranges from

Answer 415

6.1-6.9

Question 416

Normal plasma glucose is

Answer 416

less than 6